Jul 13 Health Risks for Seniors When Travelling to Remote Locations

When seniors travel off the beaten track, the risk of being struck down by a life-threatening illness or other serious medical issue is much greater than it is for younger travellers.

Backpackers in their 20s and 30s regularly trek to Everest base camp without giving much thought to possible health issues -- because food poisoning is usually the worst that happens to them -- but for over-60s any trip away from populated areas where there are quality medical facilities is going to carry some risk.

The biggest risk, of course, is that over-exertion when hiking or cycling, or even swimming in a pool at an island resort, could result in a stroke or heart attack that can’t be quickly treated because of the distance from a hospital.

Therefore older persons with a history of heart disease should have a thorough check-up with their cardiologist prior to embarking on any trip to a remote location, and follow the advice of their doctor regarding any special precautions that should be taken. Sometimes this may include carrying a supply of emergency medications such as nitroglycerin tablets that can be administered if any symptoms of a heart attack are experienced.

Surviving a heart attack

If a heart attack -- or suspected heart attack -- is experienced in a remote location, then help needs to be summoned immediately, because getting treatment within the first hour provides the best chance of surviving a heart attack.

If it’s not possible to get medical treatment within an hour, then difficult choices have to be made, especially if the traveller is a long way from civilisation.

Dr James Hubbard, author of The Survival Doctor’s Complete Handbook, calls it “judgment-call time”. In an article titled Wilderness Heart Attack: Should You Walk or Wait, he discusses the pros and cons of staying where you are and having a companion go for help, or trying to reach medical facilities to lessen the time before treatment.

He points out that, firstly, not every suspected heart attack turns out to be a real heart attack. There are many other medical problems that can cause similar symptoms. On the other hand, it is possible to have a heart attack with no symptoms at all. And there is no way of knowing whether a heart attack is real or not without medical tests.

Some people have survived heart attacks by simply resting, but that may not always be the best option, depending on what is happening to the heart.

Never travel alone

One thing is for sure, and that is any senior who is travelling to a remote location needs to have a companion with them. Hiking or cycling solo may be a great experience for younger adventurers, but once a traveller has reached the age of 60, solo travel to remote areas is too risky.

Even if older travellers are not suffering from any chronic cardiopulmonary disease, they need to understand that cardiopulmonary function is diminished very considerably compared to younger persons, and therefore they should not attempt to keep up with travellers in their 20s and 30s when joining organised hikes or cycle rides.

It is best in those circumstances to go with group of older people, or engage a guide who is willing to take a slower pace.

Dr Iain McIntosh, a travel medicine specialist at the Stirling Royal Infirmary, explained in an article published in the Journal of Travel Medicine titled Health Hazards and the Elderly Traveler that both cardiopulmonary and renal functions decline with age, so it is hard for older travellers to stay properly hydrated and to regulate their body temperature.

He also pointed out that older travellers are likely to have a lesser ability to fight intestinal infections, which is usually the most common affliction impacting travellers to remote locations, especially in the developing countries of Asia.

Precautions against food poisoning

Therefore when travelling to remote areas, seniors need to take extra care with what they eat and drink to lessen the risk of food poisoning. This includes drinking only bottled or purified water, consuming only freshly cooked food and eating only fruit that can be peeled. As much as salad vegetables are good for the health, they are too risky to eat in remote areas.

Travellers who consider that they have ‘weak stomachs’, or have previously suffered food poisoning or diarrhoea when travelling in Asia, should consider taking a supply of Travelan which is a colostrum dietary supplement that has been treated with anti-E.coli antibodies as a preventative measure against food poisoning.

The tablets are taken before meals and have a 90 percent success rate in preventing food poisoning. Even with those strains of bacteria that Travelan is not effective against, the supplement reduces the severity of the food poisoning, thus reducing the recovery time and the amount of post-infection medication that has to be taken.

Unfortunately Travelan is currently only available over-the-counter in pharmacies and drugstores in Australia and Canada, but it’s recently been approved for online sale in the US through Amazon, and travellers from other countries may also be able to purchase from Amazon subject to any restrictions that may apply to imported medicines.

Travelan is not an antibiotic -- it is a natural product -- and the only side effect that has been reported is some mild constipation with long term use.

If Travelan is not available, then taking regular doses of probiotics may help, but the effectiveness of using probiotics as a preventative measure against travellers’ diarrhoea has not been scientifically proven.

If neither Travelan nor probiotics are available, then it is essential that the older traveller keep a supply of post-infection medication and rehydration salts to hand at all times.

Avoiding physical injuries

Aside from cardiopulmonary and intestinal problems, the biggest risk for seniors when travelling is the danger of physical injury. Broken bones, fractures and concussion resulting from falls are the most common causes of preventable death amongst seniors who travel to remote areas.

A broken hip is a serious problem because it requires that the patient be immobolised, and evacuating a senior with a broken hip can result in life-threatening medical complications. Concussion is a serious issue too because sometimes that can trigger a stroke.

Therefore when hiking or cycling to a remote location, or even just walking around a jungle campsite or on a remote beach, seniors need to take extra care because one false step and a fall could have devastating consequences.

When cooking at campsites, it is best to leave the lighting of fires or connecting of gas bottles to younger members of the party (if there are any) because seniors are not as dexterous as younger persons and therefore more susceptible to burn injuries.

Know about detached retinas

Another health issue that is often overlooked when travelling to remote areas is the possibility of suffering a detached retina. Compared to the other health issues discussed in this article, the risk of having a detached retina whilst travelling is very small, but it’s important to be aware of the symptoms because a detached retina will lead to blindness if not treated very quickly.

Detached retinas occur as a result of injury to the eye (such as a punch) or as a result of aging. The vitreous jelly in the eye shrinks over the years, and in middle to old age detaches from the retina. It’s a natural process and doesn’t affect vision except in a small number of people when the vitreous jelly doesn’t come away from the retina cleanly. Instead it pulls the retina off the back of the eye -- hence the term, detached retina or retinal detachment.

Seniors who are shortsighted or who have a family history of detached retinas are most at risk. A retinal detachment can occur at any time without warning. When it does, it must be treated as a medical emergency and evacuation arrangements made to get the patient to the nearest eye hospital (or a general hospital which has a resident retinal surgeon).

Once the retinal tissue has fully detached from the back of the eye, it can’t be reinstated, and the patient will lose the sight of that eye. The detachment process can take place in less than 24 hours, or it may take a week or more. Surgery must be undertaken within that period to save the sight of the eye.

Symptoms of retinal detachment

A retinal detachment usually starts with black floaters appearing in the eye (they are actually small specks of blood or tissue) and at night ‘flashing lights’ may be seen in the eye. Often when moving the eye from side to side, a pinpoint of bright light will be seen moving around the edge of the eye.

The floaters are an indication that the retina is starting to tear, whilst the flashing lights are a nerve reaction to the vitreous jelly pulling on the retina. Sometimes this process causes small tears in the retina that can be sealed with an argon laser, but if any black patches start appearing in the eye, that is an indication that the retina is detaching, and it is at that point the situation becomes a medical emergency.

If it is practical for the patient to go to an eye hospital for a checkup when symptoms start appearing, that is undoubtedly the best course of action. If the remoteness of the location makes that impractical, then the eye needs to be monitored very closely for signs of detachment.

If a black patch appears, and then progressively becomes larger, blocking the field of vision, from one side to the other, or from top to bottom or vice versa, then the patient may have less than 6-8 hours to save the sight of the eye. Once the ‘black curtain’ has covered more than half the eye, the process of reinstating the retina will be very difficult for the eye surgeon, and is likely to result in seriously impaired vision, even if the eye can be saved.

Therefore it is imperative that the patient be operated on before the detachment is covering 50 percent of the eye. Sometimes that may mean an emergency helicopter will have to be called to airlift the patient to a hospital. The cost of that is expensive, but will be a small price to pay to save the sight of an eye.

Read our editor’s blog here about his experience with a detached retina

Vaccinations and dental checks

It almost goes without saying that travellers to remote areas need to ensure that all of their vaccinations are up to date, especially for hepatitis A, hepatitis B, cholera, typhoid, tetanus and rabies. This applies to all travellers, not just seniors. For some countries there may be other vaccinations that are required such as yellow fever, and for seniors many doctors recommend pneumonia vaccinations too.

A thorough dental checkup is also advisable because there is nothing worse than having toothache on a remote area trip. Whilst not as serious as the other medical issues covered in this article, a toothache may be untreatable until the trip is over, and will certainly turn what hopefully would have been a relaxing and energising experience into a miserable and agonising one.

Travelling to remote areas away from the stress, noise and pollution of big cities is good for the soul and should be good for the health too. Things can go wrong health wise, but being aware of the major risks and the precautions that can be taken, will help to minimise the possibility of the trip being spoilt by a serious health problem.